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Hôpital-Camfrout, France

Orefice D.,Nancy University Hospital Center | Beauvais C.,pitaux Universitaires Est Parisien | Gossec L.,University Pierre and Marie Curie | Flipon E.,Service de rhumatologie B | And 12 more authors.
Joint Bone Spine | Year: 2014

Rationale: Biodrugs carry specific risks that patients must be aware of and capable of managing. Until now, few studies have addressed the self-care safety skills of patients taking biodrugs. The primary objective of this study was to describe the self-care safety skills of patients taking biodrugs for chronic inflammatory joint disease. Methods: We conducted a nationwide cross-sectional survey. To obtain the most representative sample possible of patients taking biodrugs, we selected rheumatologists at random from the directory of the French Society for Rheumatology (SFR). Each rheumatologist was to include 5 consecutive patients receiving biodrugs. The BioSecure questionnaire was used to collect information on patient self-care safety skills. Results: Of the 677 included patients, with a mean age of 53 years, 33% were males, 62% had rheumatoid arthritis, and 47% had previously received a therapeutic patient education (TPE) session. The median BioSecure score (percentage of correctly answered items) was 73% (interquartile range, 60-82). The dimensions with the lowest scores were the symptoms requiring a physician visit (median, 75), vaccinations (median, 75), contraception (median, 50), and subcutaneous biodrugs (median, 68). The replies to theoretical items (assessing knowledge) and those to problem-case items (assessing adaptive skills) were discordant. Conclusion: This study provides concrete data of use for improving the information and TPE of patients taking biodrugs. Skills regarding the symptoms that require a physician visit, vaccinations, contraception, and subcutaneous treatments need to be improved. Interesting information can be obtained by simultaneously testing knowledge and coping. © 2014 Société française de rhumatologie. Source

Mouterde G.,Montpellier University Hospital Center | Dernis E.,Center Hospitalier | Ruyssen-Witrand A.,Service de rhumatologie B | Claudepierre P.,Service de Rhumatologie | And 10 more authors.
Joint Bone Spine | Year: 2010

Objective: To develop clinical practice guidelines about the indications of glucocorticoid therapy in early arthritis and established rheumatoid arthritis, based on previously published data and on the opinions of rheumatology experts. Methods: We used a three-step procedure. (a) A scientific committee used a Delphi procedure to select three questions about glucocorticoid indications: what is the role for glucocorticoid therapy in early arthritis? What is the role for long-term glucocorticoid therapy in established rheumatoid arthritis? What is the role for systemic glucocorticoid therapy in flares of rheumatoid arthritis? (b) Evidence providing answers to the three questions was sought in Pubmed, Embase, Cochrane, and abstracts from the annual meetings of the ACR and EULAR. (c) Based on this evidence, recommendations were developed and validated by a panel of experts. The strength of each recommendation was determined based on the level of the underlying evidence. The level of agreement among experts regarding each recommendation was measured. Results: The literature search retrieved 2851 publications, of which 36 were selected based on the titles and abstracts then on the full-length articles. These 36 studies were presented to the experts as a basis for discussion. Six recommendations rated A to D were developed and validated by the experts. They dealt with the appropriateness of low- or moderate-dose glucocorticoid therapy for a limited period in early polyarthritis after advice from a specialist and in the event of active disease, in combination with disease-modifying antirheumatic drug (DMARD) therapy; the appropriateness of low-dose glucocorticoid therapy (no more than 0.1. mg/kg/day) in RA if needed to achieve symptom control; and the appropriateness of oral glucocorticoid therapy (no more than 0.5. mg/kg/day) for 1 to 2 weeks in polyarticular flares of RA. Conclusion: The six recommendations for everyday practice presented here should help to standardize and to optimize clinical practice, thereby improving the management of patients with early arthritis or RA. © 2010 Société française de rhumatologie. Source

Patient reported outcomes have become increasingly important in the evaluation of rheumatoid arthritis (RA) over recent years. Besides pain and functional capacity, fatigue, sleep and well-being are also important for RA patients. We will discuss here the importance of patient-reported outcomes, different domains of health, and how to evaluate them, with a focus on questionnaires available in Turkey. Source

Goulenok T.M.,University of Paris Descartes | Meune C.,Service de cardiologie | Gossec L.,Service de rhumatologie B | Dougados M.,Service de rhumatologie B | And 2 more authors.
Joint Bone Spine | Year: 2010

Objective: To assess the usefulness of routine electrocardiography for heart disease screening in patients with spondyloarthropathy (SpA) or rheumatoid arthritis (RA). Methods: We included consecutive patients with SpA or RA or with degenerative joint disease (control group) admitted over a 6-month period and free of cardiovascular events. A 12-lead electrocardiogram (ECG) was obtained and was interpreted by a cardiologist who was unaware of the diagnosis. Results: We included 108 patients with SpA (mean duration, 11 ± 10 years), 106 with RA (mean duration, 12 ± 9 years), and 74 with degenerative joint disease (controls). No patient had cardiovascular symptoms or a prior history of cardiovascular disease. The only difference in cardiovascular risk factors across the three populations was a higher prevalence of diabetes in the RA and control groups. We found no differences between the SpA or RA groups and the control group regarding the rates of the following ECG findings: premature beats, atrioventricular block (2.8% in the SpA group, 1.9% in the RA group, and 2.7% in the control group), complete or incomplete left bundle branch block (0.9%, 0.9%, and 2.7%, respectively), complete right bundle branch bloc or left bundle branch block (0.9%, 4.7%, and 4.1%, respectively); and abnormalities suggesting myocardial ischemia (10.2%, 19.8%, and 17.6%, respectively). Conclusion: In patients with SpA or RA who have no cardiovascular symptoms or history of cardiovascular disease, a routine ECG shows no increase in the cardiac abnormalities specifically associated with these joint diseases, compared to controls with degenerative joint disease. © 2010. Source

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